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Updated on
April 20, 2013,
K.H.
asks from
Ladson, SC
on
April 16, 2013

HELP!!! Insurance Unwilling to Cover Newborn Son Based on Some 30 Day IRS Rule

First off, I'm not a Mom, but since Mom's seem to have all the good info relative to kids I'm hoping you'll let me crash the party!... I recently was made a father for the second time, and now, a couple months later my HR people are telling me that I can't have son on my insurance because its been more than 30 days. When my first son was born, 4.5 years ago, I didn't have to file any paperwork (we had United then as now). Whatever the insurance company needed they must have got from the hospital. Hardly a week after my son was born my company sent me to Canada for work. I was in the middle of preparing our house for sale, making preparations to receive my son, negotiating with my company, going through Canadian immigration for a work permit, and having my son. I have NEVER heard of this 30 day requirement. My HR person just kept quoting it and stating that it's in the policy. I always read the info distributed during annual enrollment, but that is from the perspective of what is covered, what are the specific, individual costs (which I'm pretty sure is the case with everyone). That said, I went back and those documents do NOT mention this. I was able to find one obscure form that briefly mentions this. However, you would never read this form unless you were adding someone to your plan (which could quite likely already be beyond the 30 days). I can absolutely NOT have my son be uncovered. I read through the 2009 posts but I'm hoping to find someone with some more recent information. I would truly appreciate any help anyone can provide, especially anyone in the insurance industry.

In response to some of the questions:

Open enrollment is in NOVEMBER, WAY too far down the road.

I think it's great that some of you are well informed on insurance policies, but I was obviously not. I didn't look into this prior to his birth because I didn't think there was anything to look into. As previously stated, I didn't file ANY paperwork for my oldest son and naturally assumed it would be the same.

The bottom line, I truly appreciate any HELP anyone can provide. I KNOW that people have been able to get around this, I'm just looking for some guidance that might help me to do the same.

Update:

I would like to send my sincere appreciation to those of you who've provided genuine advice and words of wisdom. As noted, the open enrollment is not until November which does indeed provide for coverage beginning January 1. Which for me is just too long to have my son un-covered.

I've flown the flag just as high as I'm able (which is pretty darn high). This rule was in effect and had been in effect during this event. At the root here is my responsibility to have known about this. This I do not deny. But for those that would lecture, I'm here because I made a mistake and I'm hoping for a way to correct it. I personally find it absolutely ridiculous that there would be any sort of limited window in which to add your legitimate dependents.

Further, I feel that as I was in the middle of a transfer, on behalf of my company, I would fully expect that my support of the company would be repaid in kind.

Never the less, my faith in man kind is rewarded by some of the best people I could hope to work with (a classification most certainly NOT directed toward the opposing HR or Benefits manager). These people agree with me 100% by the way. They have gone so far as to offer a subsidy for third party insurance as a PLAN B. Their PLAN A, however, is to defeat the HR opposition as they find it unacceptable as well.

I do not find insurance confusing, I find it frustrating.

Again, I am very grateful for any/all assistance. Please, if anyone has anything helpful to add I would be eternally grateful.

More Answers

It isn't an IRS rule it is an insurance rule. Open enrollment. Well they may use the IRS's definition of a qualifying event and the time frame to claim a qualifying event.

So, you can only enroll in an employer based insurance during open enrollment unless you have a qualifying event. Birth is one, death, divorce, can't remember them all but you only have 30 days to use a qualifying event.

Sorry but if this was so important to you why didn't you make sure. Even back when there weren't issues of open enrollment I was on the phone with the insurance making sure the little buggers were covered. If I didn't see the new ID cards in two weeks I was back on the phone.

Anyway, there is little you can do except wait until open enrollment and then get him on.
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Call your child's pediatrician, get a cash price for his well visits until November and make out a payment plan.

K., I hope your new son & family are doing well! Congratulations on being a new dad...

I used to work for a hospital organization, & did billing for them to the insurance companies, so that is where most of my information is based on.

Likely what happened for your first-born is that the hospital was involved in helping you/your wife get your first son covered under insurance. Most often, the mother's insurance is the same one the child will be covered under, so they can help set all of that up in the hospital.
The reasons many hospitals will do this is it ensures that not only the mother's stay will be covered, but the baby's also. (Most often, 2 separate accounts & charges are created, one for the mom up to, including & recovering from the delivery, & the second is for the baby once delivered, itemizing all of their separate care).

As people have already mentioned, there is a standard period of time for people to be added to insurance plans following a significant life-changing event (marriage, divorce, loss of job & subsequent loss of insurance for spouse, birth, adoption...) This is the window of time that someone can be added to an insurance plan outside of the normal "open enrollment" period.

It sounds like you might be beyond that window by a few months. The first thing I want to suggest is to contact the financial counselor department @ your hospital. Find out if any paperwork was ever filled out/filed on your behalf to get your son enrolled... (btw, did you go to the same hospital as the first delivery?). If so, they may have records & documentation to support fighting to get your son enrolled.

If not, ask them if they can offer any help, to either directly get your son enrolled, or offer resources for you to follow up on to do so, or even alternative insurance options if you aren't able to get him enrolled after exhausting all options.

Secondly, set up a meeting with the benefits coordinator in your HR department. Explain your lack of understanding, what the hospital did/did not do that you were expecting (for example, if your first son was covered because the hospital took care of it, you can state that you thought the same thing had taken place), etc. Ask for help, what can they do on your behalf to work with the insurance company. It is possible that HR can move mountains you cannot, because your company is involved in coordinating the benefits.

If you absolutely cannot get your son on your family's insurance until the next open enrollment period, there are still some things you can look into. I don't know all the options in your area, but there are sometimes community insurance plans (if your son has health issues, or your family is not financial secure), or affordable individual plans. If you are financially secure, it might be possible to pull an individual plan for him with a high deductible, to be used only in case of an emergent care need.

Talk to the hospital & your pediatrician. Explain the problem regarding the insurance. Hospitals in SE Wisconsin offer Self Pay discount - if you have no insurance, you get discounted b/t 25 & 45% of the bill. Your hospitals may offer that, or some type of charity care (which requires submitting paperwork & documentation to prove financial hardship, & is then granted either partially or in full based on your qualifying).

Additionally, my father was able to negotiate with his orthopedic doctor a prorated amount for office visits when he was having knee problems & in between insurance coverage (due to divorce) where the doctor charged him only what would be paid by a moderate insurance company. (say the doctor office charges $100/visit, but a large insurance company pays only $45 of that, my dad was then only charged the $45 to pay in full). Your pediatrician may be willing to do the same so that you do not have to forego any wellness visits & milestone checkups.

I know this is a lot of information, I hope some of it is helpful. Start with the hospital, then your HR department. Take notes of everything - date, time, who you talked to (name, company, position) what you asked, what they said, etc. If you get an answer that doesn't seem helpful, ask for their advice on what to do next, what resources they can recommend.

And if it comes to having to cover him yourself until the open enrollment, I would strongly suggest looking into a low-cost high-deductible plan in lieu of being strictly self-pay, just in case of an unexpected emergency.

I'm an HR professional and we always remind employees who are about to be parents to be sure and enroll their bundles of joy within 30 days. Now, if after we remind them they don't then there isn't much we can do. Especially after a couple of months.

I don't know what was different then to now BUT unfortunately, in the end it is your responsibility to take care of this. They may have been able to help if it was just a day or so but you are saying a couple of months. I don't see ANY WAY around that. It has just been too long of a time between the birth and now. Your options would be to purchase a policy, COBRA (not sure) or go without.

Unfortunately, in the end, you have learned the hard way not to assume anything when it comes to healthcare. Good luck!

Well you CAN submit a formal complaint to your ins co for denying coverage. Ask your HR person for a contact name and address. And they MUST consider your plea and give you an answer in 30 days. However, it's not likely they'll reconsider.

Many states provide temporary coverage for children with no coverage. To see if your state offers this and whether you qualify, google something like "SC State provided health care for resident children".

Meanwhile ad him to your policy when you can. Explain the situation to every provider, ask for a payment plan. Most will agree to a schedule.

I am not an insurance industry person, so ignore my comments if you are so inclined... but I am a mom who has had 2 babies, and had them added to our insurance policy, and I am pretty much the person who handles that sort of thing in our home--from health insurance, to dental insurance (and orthodontic care) to vision care and life insurance. I am involved in every detail of it in our home.

Every health insurance policy I have ever seen has an "open" period. When is the "open" season/period on your policy? Other than the open period, there are a few very specific life events that trigger the ability to make changes outside of the open period window. Typically they are things like the birth of a child, or an adoption. There IS a time limit to making changes after these events. If you miss it, you have to wait until the next open period. Usually, the life event allows 30 days after to make any changes relative to the event. So, 30 days after the birth of the baby. 30 days after an adoption is finalized. Etc.

I'm sorry that you did not check into this PRIOR to the birth. I know you were busy immediately after, but it isn't like you didn't have 9 months before the birth to look into it.

its the same with our company. its pretty standard. Can you contact public welfare and see about J. getting health insurance for the baby? We have CHIP in PA which will cover kids at 40 per month (even if you have your insurance through your work) if you make a decent amount of money or free if you are below a certain level.

Ask your HR person (very nicely) to say that you mentioned never receiving the cards in the mail and to inquire if you are in the system. When the company says no, they can backdate you due to a clerical error. But, keep in mind that you will owe for the coverage since his birth.

It's not an IRS rule - just an insurance policy rule.

If the answer is no, look into alternate policies that you can buy to cover him until November.

Furthermore, you came here for help so keep the mad tone down. :) You've received lots of help and although you are in need, it's true that ignorance is not an excuse.

Every insurance company operates a little differently. I had BCBS when my 4 year old was born, and while I did have to call to add him, they did not require me to send any paperwork. I have UHC now, and when my 1 year old was born, I called to add him and was told I had to send a copy of his birth certificate within 30 days or he would not be added.

None of this had anything to do with IRS rules, BTW, its 100% the insurance companies policy.

Not sure you will be able to get around this. I work in the industry - I have my Life & Health licence but work more with disability insurance. However with that said, the industry all works similarly and so I would think your best avenue here is to work with your HR department and get the insurance broker involved. When HR calls and demands solutions from their broker, the broker will then call the insurance company on everyones behalf and try to negotiate a solution so he can keep his client happy. Insurance carriers will fall all over themselves to try to keep the broker happy as he brings them lots of business. You need to get HR on your side first. Ask for a meeting to sit and discuss the issue. Be nice to the HR person of course, but know that if you are a "issue" she needs to get solved, she will hopfully reach out to her broker for help. No guarantees they will be able to get it done, but in my experience this is how most "exceptions" get approved in the insurance industry. You calling the insurance carrier directly will never get you anywhere in a situation like this. The folks answering the phones have no authority to do anything other than what the rule book states, and no incentive to try to get you an exception. Good luck.

Sorry to say, but you are out of luck, but maybe can find something through the state or government if you are still in Canada.

It is called a qualifying life event and you only have 30 days to add them, no exception. The next time you will be able to add him is during your open enrollment period.

I handle all the benefits for our company and this is a standard rule.

EDIT: I am not sure how far past the 30 days you are(you say a couple of months so this may not work) I did try to help out an employee who was just barely past the 30 days, by 1 week and took the blame and told them I failed to enter it into the system in time, but that the employee did the right thing and it was allowed. This probably won't work for you since you say a couple of months, but maybe talk to HR and see if they are/can do something similar.

Does your state have a Healthy Families plan? Though you may not qualify for free insurance for your son (as there are usually income limits), most states DO offer coverage that you can purchase for your children, at reasonable rates. He would just have his own little insurance plan that you would pay for separately. Then in November you could add him during open enrollment at work. He will only have a couple of well-baby visits until then, right? 2 months and then 6 months?

Sad to say, but the 30 day rule is pretty standard; if you're past it, it's unlikely that the insurance company will allow your company to enroll your baby. It's unfortunate that HR didn't proactively notify you, but since you are the father (ergo, it's not obvious like it is with women that you're about to have a baby; requesting FMLA and arranging for maternity leave and all that), they may just not have realized.

My son turned 5 in January and I had United then (still do). I am not sure when your first son was born but I was told to call the insurance company within 30 days of my son's birth to add him to my insurance. I called the first week he was home to add him and then again later that month to provide them with his social security number once it was issued because they need it for the record. I believe my manager mentioned this to me but if I remember correctly, my doctor's staff reminded me of this requirement as well. I am sorry no one thought to point this out to you. I am surprised that his pediatrician s office did not mention this to you at his first checkup, days after being brought home from the hospital. This is not a new requirement but I wish you luck.

First, the first 30 days of your son's life should have been covered on your wife's insurance (I say wife because she gave birth). Our insurance gave us 30 days to get our kids covered, but they were covered until then. So, hopefully the majority of your bills were covered during that point.

You are in a tough spot, I can sympathize (especially given the hectic situation you were in at the time of your son's birth). Unfortunately, the 30 day rule is pretty standard/cut & dry. It's always in the fine print somewhere and some do point it out more than others. At this point they do NOT have to let you add your son until annual/open enrollment.

What you can do is go to HR, plead your case. Did they know your wife was expecting? and the rest of your family was covered which would signal that your new child would need to be? Don't ask them in that way but word it nicely. Go up the chain if you need to. Also you can try the angle of "you didn't have me do any paperwork when my eldest was born, what changed?"

I personally know of a lady who had insurance through her employer. Her husband worked for same company and also had coverage. While she was out on maternity leave/FMLA, she didn't think about having to "add" her son since insurance covered the pregnancy and delivery. She also assumed that HR would let her know what/if anything she had to fill out since they knew she was out on maternity leave and she had all her FMLA paperwork. They should have but didn't. She also should have checked with them but didn't...until claims beyond the initial hospital stay was not being paid. In her case, she plead her case up the corporate ladder until the VP of HR acknowledged that HR/Benefits dropped the ball by not at least calling her about it. I believe they ended up getting him covered but it was a huge hassle.

I also saw here on Mamapedia that a lady had twins. I believe one didn't make it and the other was in NICU (not sure the outcome of that baby) for an extended period. Later, she started receiving bills for the NICU stay that were not being covered. Same situation. Not sure her outcome but that was only like a year ago so if you search it, you may find some feedback on that thread too.

Not in the insurance industry, but with our benefits, we have 30 days to add a newborn/adopted child to our coverage.
I DO remember adding our son ten years ago.
When added, benefits apply retroactively to DOB.
Same goes for adding a spouse.
You may well be out of luck until open enrollment again.
Stinks. Sorry. :(

ETA: there are 7-9 months til you can add him. Unless your baby if a high medical needs baby, that ought to be about 3 office well child check ups & shots. Maybe (worst case scenario if you pay out of pocket) might not be as bad as you think!

I don't know if your problem can be resolved to meet your needs, but I'll tell you what my dad told me when I was having insurance problems. Just keep calling. If you're getting stonewalled with HR, call the insurance company directly. If you don't get the answer you need, call again and talk to someone else. You may find someone who listens to your story and decides to make an exception. It's also possible that you NEVER find someone who listens, but you need to try. It only takes one person on your side at the insurance company, so find that person.

In my case, my insurance wouldn't cover any of my pregnancy care because they considered it a "work place injury." Seriously. And NO ONE would stop, listen, and think. I called over and over for days, till finally someone actually listened to what I was saying and said "OMG, that's ridiculous, of course you're covered!"

I'm not aware of a way around this, other than taking out a 6 month policy on him for interim coverage.
The 30 day rule is not well published...I almost missed it after I had my son, and had no idea at the time.

But I'm also pretty sure this is not a battle you'll win with your insurance provider. So I'd say the best course of action is to get him coverage now...and deal with whatever you'll have to pay, so that you don't have to deal with the fun of pre-existing conditions for corporate coverage. (Or is that gone now under Obamacare? Sorry, I'm not up to speed...)

There is a limit, but you can always write a letter to the company (insurance) asking them to allow your son to be added. Be sure to include the reasons. Don't use emotional language or emotional pleas. Use facts and factual language.
Also, the Kiss, Slap, Kiss method sometimes work. That is: compliment (or kiss up), complain and ask for how you want it fixed, end with another kiss up.
Insurance companies are notorious for never 'bending', but you never know until you try.

EDIT: I had a family ICU policy that I took out in August one year. The rep 'forgot' to submit my payroll deduction paperwork and they were about to cancel me. I got in touch with the regional rep as I was already pregnant and needed the policy to be in effect for 10 months before I gave birth or they wouldnt' cover the baby/babies if they had to be in the NICU. I sent him a check directly by overnight mail and he fixed it.
Then when we conceived twins our due date would have had them covered but they came early (within the 10 month grace period) so Aflac denied the claim.
I fought for a year on my own. Then I found the old contact number for the regional rep. He had it fixed within a week as I recieved a check for each daughters 17 day NICU stay within 10 days!

No. People haven't "gotten around" this. Unfortunately, if you don't add them within 30 days, you have to wait until enrollment.

Sorry that you got caught off guard - maybe a private insurer will sell a single policy to cover the next 6 months? Or maybe united will offer a seperate market priced coverage.
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you are aware that YOU have to apply for their social security cards, right? Also wouldn't be a bad idea to get extra copies of the birth certificate - also YOUR responsibility.

Well, back once upon a time when this mama worked for the all 3 of the major insurers in this area, it was 30 days or you'd have to wait for your company's open enrollment. And the baby's hospital stay is covered under the mom's id # and authorization while SHE is in the hospital...should the baby need to stay after mom has gone home, baby needs to be on the policy and it becomes a separate claim....Does your wife have another policy of her own to which she may have added the baby? Good luck... I wish you and your family well

i know for a fact united DOES require a birth certificate for coverage, we had to submit it 7 years ago when my son was born and the same when my daughter was a year ago. here in florida the birth certificate is available the day its submitted we picked it up on the way home from the hospital and got it in that day. I'm not sure theres much you can do.

There is a 30 day window, but it applies to how pre-existing conditions are handled. You should still be allowed to enroll your child in your insurance program, but if he already has known health issues those issues may not be covered by insurance.

It is a life status change, and there's 30 days for those to occur. That is always in open enrollment paperwork. When you go through it in November, I'm sure you'll notice it this year.

Also, not to put a damper on things, but even though your company's open enrollment is in November, that is likely for coverage that begins January 1.

It's not an ideal situation to have an uninsured child, but if your child is normal and not sick, you should be fine paying out of pocket until January.

It sounds like you might find open enrollment and your company's health insurance process a little confusing. It might be a good idea to set up a meeting with someone from HR so they can go over everything and explain it clearly. That will help prevent future mistakes.

Most do have a 30 day life change rule. It stinks that you didn't know, and I think you should try to fight, but you need to look into alternatives. Even if you win the fight you have to deal with the now. If you do go the new policy route, realize that it will take time. I was surprised how long it took for them to write it. You still need a backup plan for that time.

We got individual coverage which isn't terribly expensive for the first year - we also had a gap while the policy went in place and luckily had a super pediatrician to help us through it. You can look at paying the pediatrician out of pocket (talk to them first, they may be helpful and charge differently). For immunizations you can go to county health services (or the like) and will be charged on a sliding scale that is still cheaper than your pediatrician - talk to your ped about this too they can give you guidance and you will want to keep your child records up to date there.

I would call the HR dept and see if they will work with you as well as the insurance company. Explain what you told us and and see if they will give you any leway. It is unacceptable to have to not have your kid insured because of this. I was aware of the rule but maybe if your super nice, they will work with you. Good luck!

I'm very sorry this happened, dad, but you don't have a leg to stand on. I don't think that you CAN get around this. ALWAYS be in the know anytime there is a life event change, and that includes if you change jobs.

Perhaps you can find stop gap insurance between now and November. It will probably just cover catastrophic insurance and will be very expensive. MAKE SURE you take your baby to his well baby visits and any sick visits. An ounce of prevention is worth a pound of cure. Getting him to the doctor quickly can prevent an expensive hospital visit. Don't scrimp simply because you don't have insurance. Pay the doctor bills out of pocket. Before you know it, November will be here and he will be covered.

Don't make this mistake ever again - ANY life changing event needs to be researched when it comes to insurance. I know of people who didn't change jobs BECAUSE of the way it would have affected their insurance. They made it their business to find out how in advance, knowing that rules change as time goes by...

Sounds like someone in HR did the paperwork to add your first child, probably as a courtesy since you were a new parent. Didn't happen the 2nd time around. This policy is not new and has never been hidden anywhere I've worked (2 major corporations). When it comes to these things, one must never assume, and one must be proactive, I'm afraid. I think you're out of luck on this. A healthy baby shouldn't need that much healthcare, anyway. You're only talking about 8.5 more months of being uninsured. I'm sure it'll all work out.

Find out what is/isn't covered. My DD was a day or two past the 30 day mark and the HR folks worked with the insurance folks and got her covered for her "spring the kid from the hospital" visit, but she was otherwise covered for healthcare because we'd already informed the HMO about her (I was using my PPO for prenatal care). Now, if you are having immigration paperwork as another layer, your mileage may vary. What I would do is ask for the insurance representative for your company and/or call the insurance company and talk to them. See if there are any ways to petition them to add your child at this point, and if not, is there any other way to insure your child, even if it's basically a COBRA plan.

Yup, sorry. 30 days for life events. I do medical billing and when we check someone's insurance to verify their coverages we ask that question and let the families know, sorry someone didn't do that for you. I agree that if your baby is healthy you can probably get by with paying cash for healthcare until open enrollment, or perhaps qualify for state insurance with the proof your child can't get on your insurance, or buy them an individual policy for the time being. And yes as a reminder in case you weren't sure, you do need to request ssns for your kids if your medical provider or hospital didn't do it, it is a good idea to have extra copies of birth certificates, but shots are NOT required for school in all but two states, waivers are available. If you're going to follow the "normal" vaccination schedule see if they're covered by the state for an underinsured child, or perhaps consider an alternative schedule. Yes you should have checked on the insurance, but I can tell you most people don't, it is all confusing!